How Our Balance System Works

Balance and equilibrium help us stay upright when standing and know where we are in relation to gravity. Our balance system also helps us walk, run, and move without falling. Balance is controlled through signals to the brain from your eyes, the inner ear, and the sensory systems of the body (such as the skin, muscles, and joints). This balance system is also known as the vestibular system.

In the inner ear, the balance system consists of three semicircular canals that contain fluid and “sensors” that detect rotational movement of the head. Each of the semicircular canals lies at a different angle and is situated at a right angle to each other. The semicircular canals deal with different movement: up-and-down, side-to-side, and tilting from one side to the other. All contain sensory hair cells that are activated by movement of inner ear fluid (endolymph). As the head moves, hair cells in the semicircular canals send nerve impulses to the brain by way of the acoustic nerve. The nerve impulses are processed in the brain to help us know where we are in space or if we are moving.

Located near the semicircular canals are the utricle and the saccule. The ends of the semicircular canals connect with the utricle, and the utricle connects with the saccule. The semicircular canals provide information about movement of the head. The sensory hair cells of the utricle and saccule provide information to the brain about head position when it is not moving. The utricle is sensitive to change in horizontal movement. The saccule is sensitive to the change in vertical acceleration (such as going up in an elevator).

Balance Testing

Balance system assessment is often recommended when a person has:

Rapid, involuntary eye movement (also known as nystagmus)

Complaints of vertigo or dizziness

Balance dysfunction

Gait abnormalities

Suspected pathology or disease of the vestibular system

Tests of the balance system are performed to determine:

What is causing the symptoms?

Where in the balance system is the problem occurring?

Are any changes happening in the balance function?

How are vision, the inner ear, and sensory systems impacting functional balance?

Some of the tests of balance can be done in the physician’s office or at the bedside in the hospital. Others require specialized equipment that is in the audiology office or clinic.

What should I do if I have a problem with balance or dizziness?

It is important to see your doctor if you have unexplained dizziness or balance issues. If you have any of the following other symptoms, be sure to seek emergency medical care:

Chest pains

Numbness or tingling

Falling or problems walking

Weakness in the legs or arms

Blurred vision

Slurred speech

Sudden hearing loss

Severe neck stiffness

Head trauma or injury

High fever

Dizziness and balance difficulties are symptoms of another problem. The first thing you should do is try to find out the underlying cause. You should have a medical examination with special attention given to checking for problems that can be associated with balance difficulties.

Unfortunately, in many cases, the dizziness and balance difficulties cannot be treated medically or surgically. In these cases, the balance problem itself may need to be treated through balance rehabilitation.

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About Us

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 186,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.